Medication can help people with mental health issues cope better, and benefit from other treatment. They are prescribed and taken to exert an effect on the chemical makeup of the brain and nervous system.
Psychiatric drugs were developed in the mid-20th century. In 1948, lithium was first used as a psychiatric medicine. One of the most important discoveries was chlorpromazine, an antipsychotic that was first given to a patient in 1952.
Ketamine, a dissociative anaesthetic with hallucinogenic properties, is a derivative of phencyclidine and was developed in the 1960s. In 1964, ketamine was experimentally administered to human subjects to test the safety and general anaesthetic properties of ketamine, and the subjects reported few side effects and described feelings of floating or having no feeling in their limbs. Ketamine was approved by the FDA in 1970 for use as a short-acting anaesthetic in humans and animals and was given to injured American soldiers during the Vietnam War.
In 2000, the noncompetitive NMDA receptor antagonist ketamine was first used in a “proof of concept” randomized, double- blind study to assess the effects of ketamine on MDD in seven patients who received both vehicle and ketamine treatment (counterbalanced). A single, subanesthetic dose of ketamine (0.5 mg/kg) was intravenously (i.v.) infused over 40 minutes, and the antidepressant effects of ketamine were assessed using the Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventor (BDI). In comparison, an anesthetic dose for ketamine in humans ranges from 1.0 mg/kg to 4.5 mg/kg intravenous and from 6.5 mg/kg to 13.0 mg/kg intramuscular. In this study, ketamine produced rapid, within four hours, and prolonged antidepressant effects that lasted up to 72 hours as compared to placebo control This rapid antidepressant effect of ketamine is far superior to the 4-12 week delay with current antidepressant drugs.
Ketamine is a licensed anaesthetic drug. It can also work as an antidepressant but has not
been licensed for this use. NHS Trusts could start to use ketamine off-label now; however, many are reluctant to do so without ‘authorisation’ from NICE whose guidelines on treatments for depression make no reference to ketamine. A closely related version, nasal esketamine, does have a licence but
has not been approved for routine NHS use, mainly because of cost.
In the late 1960s evidence began to emerge suggesting the significant role of serotonin and In 1974, the first report on the selective serotonin reuptake inhibitor (SSRI) LY110140 (fluoxetine) was published and the authors suggested that fluoxetine would be an antidepressant drug. Development of selective serotonin reuptake inhibitors (SSRIs), which act on serotonin transporters in the brain to increase levels of serotonin in the synaptic cleft continued and expanded. The next “atypical” antidepressant drug, venlafaxine, was introduced to the United States market in 1993, and this drug selectively targets the serotonin and norepinephrine transporters. The immediate release form of venlafaxine (Effexor®), a serotonin-norepinephrine reuptake inhibitors (SNRI), was approved by the FDA for the treatment of MDD in 1993.
The exact chemicals that are targeted depend on which class of medicine is being prescribed. The various chemicals that are targeted include dopamine, serotonin, noradrenaline, and gamma-aminobutyric acid.
Types of Mental Health Medicines
There are four major types of medicines used in the treatment of mental health conditions:
- Antidepressants
- Antipsychotics
- Mood Stabilisers
- Benzodiazepines
Antidepressants
Antidepressants are the most well-known and most-used class of mental health medicines. They are typically used in the treatment of conditions like Depression, Anxiety, Trauma-related conditions and Eating Disorders among others.
Within this class of medicine, there are a range of sub-types. These include Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclic Antidepressants among others.
It isn’t entirely known how antidepressants work. They target certain chemicals in the brain which are believed to be responsible for the regulation of mood, and motivation. Each sub-type of antidepressant has its own mechanism of action.
Antidepressants can take 4-6 weeks for their full effect to be felt. Most people find they make a positive difference to their symptoms. They are most effective when combined with a form of talking therapy.
Well-known Antidepressants include Fluoxetine (Prozac), Citalopram (Celexa), Sertraline (Zoloft), and Paroxetine (Seroxat). There are a huge range of antidepressants in total.
Antipsychotics
Antipsychotics are a class of medicines that can help in the treatment of conditions that involve psychotic elements – such as paranoia or hallucinations. Moreover, this includes Psychosis, Schizophrenia and some cases of Bipolar Disorder.
Antipsychotics are generally divided into two sub-types. These are “typical” antipsychotics and “atypical” antipsychotics. Typical antipsychotics are older generation medicaments, while atypical antipsychotics are newer drugs. However, both are effective.
It isn’t entirely known how antipsychotics work. It is known that they block dopamine receptors in the brain – which essentially reduces the level of dopamine. Excessive dopamine is believed to be a cause of psychosis.
Antipsychotics usually begin to work after around 2 weeks. It can take several weeks for their full effects to be felt. Many people combine this medicine with some form of talking therapy.
Mood Stabilisers
Mood Stabilisers are a class of medicines that are used primarily in the treatment of Bipolar Disorder. They can also be used as an add-on treatment for cases of Depression, or some Psychosis conditions.
There are just a few mood stabilisers, with Lithium the most well-known of these. Others include Sodium Valproate (Depokate) and Lamotrigine (Lamictal).
It isn’t fully understood how mood stabilisers work. It is believed that these medicines influence neurotransmitters in the brain which are linked to mood fluctuations. Essentially, they aim to balance and stabilise moods.
It can take 2-6 weeks for mood stabilisers to take full effect. But minor changes can be felt within a few days. Most people find that mood stabilisers improve their symptoms.
Benzodiazepines
Benzodiazepines are a class of mental health medicines. They are often used as a short-term treatment in cases which involve extreme anxiety or agitation. They should only ever be used as a short-term measure, rather than taken on a long-term basis – due to the risk of addiction.
Benzodiazepines work as central nervous system depressants. They target the gamma-aminobutyric acid neurotransmitter in the brain. By doing so, they can induce calmness, drowsiness and sleep.
Benzodiazepines generally work very quickly. Most people feel their effect within around 30 minutes of taking the drug. Depending on the strength of the medicine, feelings can last anywhere from 3-6 hours.
As mentioned above, benzodiazepines should only be taken in the short-term. They are addictive, and many people can become dependent on them. Unfortunately, due to their effects, they are a commonly abused drug.
A huge range of medicines exist in this class. The best known benzodiazepines are Diazepam (Valium), Alprazolam (Xanax), and Lorazepam (Ativan) among others.
When Medication Works – Pros
When a mental health medicine is taken as prescribed, it is mostly safe. These medicines have been rigorously tested.
When mental health medicine works, it can be a literal life-saver! Many people find that medicine can result in a better quality of life.
There are many positive effects of mental health medicines. When taking medicine, a patient may become more motivated, have more interest in life and generally feel more positive among other good improvements!
Cons of Medication
Side effects from mental health medicines are common. While each individual medicine will have their own potential side effects, common effects include:
- feeling agitated, shaky or anxious
- feeling and being sick
- indigestion and stomach aches
- diarrhoea or constipation
- loss of appetite
- dizziness
- not sleeping well (insomnia), or feeling very sleepy
- headaches
- loss of libido (reduced sex drive)
- difficulties achieving orgasm during sex or masturbation
- difficulties obtaining or maintaining an erection (erectile dysfunction)
Mental health medicines aren’t a quick fix. With the exception of Benzodiazepines, mental health medicines typically take a minimum of 2 weeks to start working. They often take up to 4-6 weeks for their full effect to be felt. Unfortunately, they do not provide an immediate boost.
While mental health medicines can treat the symptoms of mental illness, they are unable to tackle underlying causes. For many people, this won’t be an issue. However, for anyone with more deep-seated issues or past trauma, medicine will only have a limited impact. Talking therapy is often useful in this case.
Further to the above, talking therapy is often considered to be more effective than mental health medicines. As discussed, this is because talking therapy tackles the underlying causes behind mental health conditions. It also offers the patient a chance to focus on themselves.
Unfortunately, there is still a stigma associated with mental health medicines. Some people will find it uncomfortable to tell others, including employers and loved ones, that they take some form of psychiatric medicine.
Mental health medicines usually cost money. For those living in England, there is a prescription charge for medicine. Although please note that for those that meet certain eligibility criteria and for those in Scotland and Wales, it is free.
Although the medication is not always physically addictive, many people will struggle to be able to stop taking it and will be on it in the long term.
